Single Sessions
Individuals:
½ Hour -$15 member/ $20 non-member
45 Minutes- $20 member/ $25 non-member
1 Hour- $25 member/ $30 non-member
Small Group (2-4 people):
1 hour- $20 member/ $25 non-member
*RATES BASED PER PERSON
Bulk Sessions
Individuals:
Purchase 6 sessions, get 1 FREE!
½ Hour- $90 member/ $120 nonSmall Group (2-4 people):
member
45 Min- $120 member/ $150 nonPurchase 6 sessions, get 1 FREE!
member
½ Hour- $75 member/ $105 non1 Hour- $150 member/ $180 nonmember
member
1 Hour- $120 member/ $ 250 nonPurchase 10 sessions, get 2 FREE!
member
½ Hour- $150 member/ $200 nonPurchase 10 sessions, get 2 FREE!
member
1 Hour- $200 member/ $250 non45 Min- $200 member/$250 nonmember
member
*RATES BASED PER PERSON
1 Hour- $250 member/ $300 non-member
For more information please contact Program Coordinator, Chelsea Edwards
chelseae@lockhavenymca.org
General Information
Name____________________________________________________
M/F__________
D.O.B____________________
Address___________________________________________________________________________________________________________
Home Phone_________________________
Cell Phone__________________________
Email_______________________________________________________________________________________________________________
Parent/Guardian Information (if under age of 18)
Name____________________________________________________
M/F__________
D.O.B____________________
Address___________________________________________________________________________________________________________
Home Phone_________________________
Cell Phone__________________________
Email_______________________________________________________________________________________________________________
Emergency Contact Information
Name____________________________________ Home Phone_____________________ Cell Phone______________________
Address___________________________________________________________________________________________________________
Email_______________________________________________________________________________________________________________
So that we may best match you with a trainer, please list the days and times that you are
available for personal training:
Sunday
Monday
Tuesday
Wednesday Thursday
Friday
Saturday
Time 1
Time 2
Time 3
Please list any injuries or contraindications to exercise: _____________________________________________
Please list your fitness goals: _______________________________________________________________________________
If you wish to have a particular trainer, let us know: __________________________________________________
Informed Consent:
I understand that YMCA activities, have inherent risks and I hereby assume all risks and hazards incident to
my participation in the YMCA’s Personal Training. I further waive, release, absolve, indemnify and agree to
hold harmless the YMCA, the organizers, volunteers, supervisors, officers, directors, participants, coaches,
referees, as well as, persons or parents transporting participants to and from activities from any claims or
injury sustained during my use of the YMCA’s property. I give the YMCA staff permission to administer first
aid/CPR for all minor injuries and to seek professional treatment if needed. The YMCA also has my permission
to photograph me while participating in YMCA programs. Finally, by signing this form, I agree to pay the Lock
Haven YMCA the specified amount due for participation in YMCA programs.
Signature: _____________________________________________________
Date: ____________________________
Please return your completed registration form to the front desk staff. A trainer will contact you to schedule an appointment. Payment
for the number of sessions you choose is due at the time of your first appointment with your trainer. Training sessions must be used
within one year of purchase. No refunds for unused sessions. Thank you!